Introduction. Leiomyoma uteri is one of the most common benign conditions for which women undergo hysterectomy every year. Fibroids found retroperitoneally are a rare entity, especially, primary retroperitoneal fibroid. Case Presentation. We report a case of 42-year-old para 1 who presented to our hospital with recurring retention of urine, lower abdominal and pelvic pain, and dyspareunia . Provisional diagnosis on the basis of examination and imaging was large subserosal fibroid with mild right-sided hydroureteronephrosis, due to pressure effect of the fibroid. Abdominal hysterectomy was done for the patient, and intraoperatively, a bulky uterus was found with multiple small fibroids on anterior and posterior walls, and a large fibroid approx. 10 × 8 cm was found arising from the posterior surface at the level of internal os retroperitoneally, which was confirmed by histopathology as leiomyoma. Conclusion. Retroperitoneal fibroids are rare neoplasms and treatment is surgical removal. Preoperative imaging can only give provisional diagnosis and can be misguiding. Final diagnosis of retroperitoneal fibroid can be made only intraoperatively.
Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases.
Application of uterine fundal pressure in a delivering woman was not only ineffective in shortening the second stage of labor but added to the risks during parturition.
Minilaparotomy hysterectomy through ≤5 cm Pfannenstiel incision provides an appealing, effective, expeditious, minimal access and less invasive cost-effective option/alternative to the traditional abdominal approach obviating the need for any additional expensive equipment and, above all, improves upon the perioperative outcome, notwithstanding, whatsoever, on the quality of surgery.
Using dinoprostone followed by vaginal misoprostol is safe and effective for induction of labor with less need for oxytocin augmentation and shorter induction delivery interval.
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